Regional variation in medical practice gets a lot of press. I
first read about the use of diazoxide and trimethaphan in hypertensive
emergencies as a medical student in the late 1970s and most recently in
CHEST (July 2000).1 Yet for > 2 decades of
practice in at least a half-dozen Southern California hospitals, I have
never seen either agent used. This may be a parochial view, but it
seems hazardous to recommend drugs with which ICU staffs have little or
no familiarity. I am reminded of the old saw, “Be neither the first
nor the last to use a drug.”

References

To the Editor:

We appreciate Dr. Frank’s comments regarding the use of
diazoxide and trimethaphan in our review of hypertensive crises in
CHEST.1 It is true that regional variations
exist in the use of antihypertensive agents. The pharmacopeia of
individual hospitals are clearly different, and we must understand that
the readership of CHEST is quite diverse, including
physicians from around the world. Drugs like trimethaphan and diazoxide
have been supplanted by other agents in most areas of the United
States. However, these agents remain available here and around
the world. A review of hypertensive crises would be incomplete without
mentioning these treatment alternatives.

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